The Glucagon-Like Peptide-1/GIP Drugs
Dr. Morstein is sure that everyone has heard of these highly advertised medications. It's time to talk about them and bring some clarity to what they are and how to use them.
First off, these are NOT new drugs. GLP-1 injections have been around since 2005, nearly 20 years. The fact that you've just heard about them is one thing; Dr. Morstein has been safely and effectively using them with patients since they first came out.
In 2005 this class of drugs was FDA approved for Type 2 diabetes patients, to help control their glucose, help them reduce appetite and lose weight.
Two years ago they were FDA approved specifically for weight loss and that's when they burst more onto the scene. After all, there are many other meds for diabetes, but weight loss, an easy treatment for that, really sparked peoples' interests.
How do these drugs work?
Glucagon like peptide 1 receptor agonists do several things in the body:
1. Increase insulin
2. Reduce glucagon
3. Slow down gastric emptying
4. Slow down appetite
In this regard, people are less hungry, and can more easily lose weight. Glucose levels can reduce as more glucose is getting into cells, and with the slowing of digestion, food is broken down slower and glucose is formed slower from your meal. People can lose 30-40 pounds over the months on the medication.
The main drug in this class now is Semaglutide: brands names using that drug are Ozempic, Wegozy, and Rybelsus. Rybelsus is the only medication in this class that is a daily oral pill. All the other drugs are injected once a week.
The other medication used with GLP-1 is Gastric Inhibitory Peptide, which does very similar actions as GLP-1. It is added into the GLP-1 medication in drug Tirzapidine, brand name Mounjaro. It is also injected weekly.
Trulicity is another GLP-1 medication, but it is not FDA approved for weight loss; it's only for diabetes control, which is still a good thing! It's also injected once a week.
These medications are so popular that the manufacturer of Ozempic, NovoNordisk, actually stopped producing a type of insulin called Levemir, to allow it to produce more Ozempic. Five years ago, it cost a patient around $330 a month to buy these medications, but now it's $1000/month or more.
However much Google wants people to think these drugs cause all types of serious problems, Dr. Morstein can assure you, they don't! In 19 years of using them regularly with patients, only one patient developed a side-effect, some diarrhea, and when changed to a different type of GLP-1 injection, he was fine. People may get some nausea, or gut upset, but it's not too common. That's because these drugs are titrated up slowly month by month, so the body has plenty of time to get used to them.
For example, Ozempic is dosed at 0.25 mg weekly the first month, then 0.5 mg a week for the second month, then 1 mg a week for the third, and then by the fourth month, the highest dose of 2 mg is reached. Some patients do not even get to the highest level as they do very well on a lower dose and there's no need to go higher. Rybelsus dosing is 3, 7, 14 orally over three months.
The problem is that many illegal forms of compounded Semaglutide are on the market. This occurred due to back orders in the company's form. Compounded semaglutide is typically given at non-standard dosing and some patients may be told to inject twice a week, which is NOT good. Do not do that!
When a patient is using one of these medications correctly, with the real formula, dosed in the titrating method month to month, side effects are typically non-existent. No one gets a paralyzed stomach!
GLP-1 drugs should not be given to patients who have had medullary thyroid cancer or a rare MEN tumor. Patients with a history of pancreatitis shouldn't probably get it (pancreatitis is also a very, very rare side-effect Dr. Morstein has never seen). It's not approved for pediatric patients.
These medications are safe to use and effective for weight loss and diabetes control. Dr. Morstein uses them as the second medication after Metformin in Type 2 patients, and as the primary medication in patients without diabetes needing weight loss. Unfortunately, though GLP 1 and GIP injections are FDA approved for weight loss, many insurances are not yet covering it for that indication.
If you are interested in investigating this medication, please contact Dr. Morstein for an appointment.